Peripheral Arterial Occlusive Disease (PAOD) is the term commonly used for severe narrowing to complete obstruction of the peripheral arteries, mostly in the arms and legs. This causes a critical reduction in blood flow to the organ supplied by the artery, resulting in permanent damage to the affected organ.
Progression of Arterial narrowing, causing critical reduction in blood flow.
The most common cause for PAOD is Atherosclerosis, which is age related narrowing in the arteries due to cholesterol deposition on the walls of the artery. Next most common cause is Smoking or tobacco chewing, which may lead to PAOD in any age group, and most affected are young patients who are heavy smokers.
A narrowed leg artery due to Atherosclerosis
Symptoms of PAOD include cramping pain and tiredness in the muscles of the calf and thigh region, mostly during walking. In early stages, patient develops Claudication (Pain occurs on walking for some distance, relieved by rest, and then the patient can walk again, pain-free for some distance until the cycle repeats)
Claudication pain occurs in the thigh and calf muscles
In late stages, severe pain is present on the foot even at rest, and the patient is not able to sleep due to this pain. Foot or toe wounds may develop that are extremely painful and do not heal with regular treatment. As the disease worsens, the leg becomes cold with blackening and drying up of skin (Gangrene). This stage of PAOD is known as a LEG ATTACK, and requires immediate treatment in the form of Revascularisation.
A typical LEG ATTACK leading to Gangrene.
Treatment options for PAOD are both Surgical or Endovascular, and a Vascular Surgeon is the specialist for both forms of treatment. Surgery involves a Bypass of narrowed/obstructed arterial segment with an autologous vein or artificial tube graft.
An example of a surgical bypass of the Femoral artery using an artificial tube graft
Endovascular interventions for PAOD include Balloon angioplasty and Arterial stenting. Any delay in revascularisation causes irrepairable damage to the involved limb, which later results in amputation.
Balloon angioplasty procedure leads to widening of the narrowed artery, improving blood circulation
Stenting of a narrowed artery leading to improvement in the blood flow.